Provider Demographics
NPI:1992218366
Name:HENRY, ANDREANE
Entity Type:Individual
Prefix:
First Name:ANDREANE
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDREANE
Other - Middle Name:
Other - Last Name:THELEMAQUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:THELEMAQUE
Mailing Address - Street 1:924 BUCKLEY RD
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-1523
Mailing Address - Country:US
Mailing Address - Phone:781-264-1154
Mailing Address - Fax:
Practice Address - Street 1:924 BUCKLEY RD
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1523
Practice Address - Country:US
Practice Address - Phone:781-264-1154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor